Notification of Changes for Business Entity
General Information
Business Entity Name:	OWNERGUARD CORPORATION
Incorporation / Formation Date:
FEIN:	33-0667314
Ohio License Number:	25280
NPN:	2753799
DBA / Trade Name:
State of Domicile:	CA
County:	SAN DIEGO
Business Address
Address 1:	1785 HANCOCK ST STE 100
Address 2:
City:	SAN DIEGO
State:	CA
Zip:	92110
Phone:	860-571-3104
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	8995 WESTSIDE PARKWAY
Address 2:
City:	ALPHARETTA
State:	GA
Zip:	30009
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
NATHAN GREER	SECRETARY	451-77-2609	YES		06/01/2018
SEAN STAPLETON	DIRECTOR	076-52-3927	YES		06/01/2018

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	CATHY KIMMEY
Title:	LICENSING SPECIALIST
Phone Number:	972-788-6811
Email Address:	PRODUCER.LICENSING@AMTRUSTGROUP.COM